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Sodium Acetate

Pronunciation

(SOW dee um AS e tate)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous, as anhydrous:

Generic: 2 mEq/mL (20 mL, 50 mL, 100 mL); 4 mEq/mL (50 mL, 100 mL)

Pharmacologic Category

  • Electrolyte Supplement, Parenteral

Use: Labeled Indications

Sodium source in large volume IV fluids to prevent or correct hyponatremia in patients with restricted intake; used to counter acidosis through conversion to bicarbonate

Contraindications

Hypernatremia and fluid retention

Dosing: Adult

Note: Sodium acetate is metabolized to bicarbonate on an equimolar basis outside the liver; administer in large volume IV fluids as a sodium source. Refer to Sodium Bicarbonate monograph.

Maintenance electrolyte requirements of sodium in parenteral nutrition solutions:

Daily requirements: 3-4 mEq/kg/24 hours or 25-40 mEq/1000 kcal/24 hours

Maximum: 100-150 mEq/24 hours

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Maintenance electrolyte requirements of sodium in parenteral nutrition solutions: IV: 3-4 mEq/kg/24 hours

Dosing: Renal Impairment

No dosage adjustment provided in manufacturer’s labeling. Use with caution.

Dosing: Hepatic Impairment

No dosage adjustment provided in manufacturer’s labeling. Use with caution.

Administration

Must be diluted prior to IV administration; infuse hypertonic solutions (eg, >2.8% sodium acetate in sterile water [2.8% sodium acetate in sterile water has osmolarity approximately equivalent to 2% sodium chloride]) via a central line (Mortimer, 2006; Suarez, 2004). If diluted in D5W or other solution, the osmolarity may be higher requiring central line administration at a lower sodium acetate concentration.

Consult individual institutional policies and procedures.

Dietary Considerations

Sodium acetate anhydrous (2 mEq/mL): 1 mL = 164 mg sodium acetate anhydrous = 2 mEq of sodium (46 mg) and acetate (118 mg)

Storage

Store at room temperature of 20°C to 25°C (68°F to 77°F).

Drug Interactions

There are no known significant interactions.

Adverse Reactions

1% to 10%:

Cardiovascular: Thrombosis, hypervolemia

Dermatologic: Chemical cellulitis at injection site (extravasation)

Endocrine & metabolic: Hypernatremia, dilution of serum electrolytes, overhydration, hypokalemia, metabolic alkalosis, hypocalcemia

Gastrointestinal: Gastric distension, flatulence

Local: Phlebitis

Respiratory: Pulmonary edema

Miscellaneous: Congestive conditions

Warnings/Precautions

Concerns related to adverse effects:

• Hypernatremia: Close monitoring of serum sodium concentrations is needed to avoid hypernatremia.

Disease-related concerns:

• Acid/base disorders: Use with caution in patients with acid/base alterations; contains acetate, monitor closely during acid/base correction.

• Edema: Use with caution in edematous patients.

• Heart failure (HF): Use extreme caution in patients with HF; monitor closely for edema.

• Hepatic impairment: Use with caution in patients with severe hepatic impairment.

• Renal impairment: Use with caution in patients with renal impairment; monitor serum sodium concentrations closely.

Dosage form specific issues:

• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer’s labeling.

Other warnings/precautions:

• Extravasation: Avoid extravasation.

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted. Sodium requirements do not change during pregnancy (IOM, 2004).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Have patient report immediately to prescriber signs of fluid and electrolyte problems (mood changes, confusion, muscle pain or weakness, abnormal heartbeat, very bad dizziness or passing out, fast heartbeat, more thirst, seizures, feeling very tired or weak, not hungry, unable to pass urine or change in the amount of urine produced, dry mouth, dry eyes, or nausea or vomiting (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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